Tugce Hilal Ucgun

Objective: Neoadjuvant chemoradiotherapy (NACRT) plays an important role in the treatment of esophageal cancer. Current studies show that increased pathological response and R0-resection rates positively affect treatment outcomes. This study aimed to evaluate the clinical outcomes of patients who received NACRT with or without surgery. Methods: In this study, 72 patients diagnosed with esophageal cancer who underwent NACRT, with or without subsequent surgery, were retrospectively analyzed. Radiotherapy (RT) fields were defined based on the primary tumor location, and the median RT dose was 50.4 Gy (range: 41.4–54 Gy). The patients received a chemotherapy regimen consisting of 5 cycles of carboplatin and paclitaxel. Following CRT, patients who were eligible for surgery depending on their pathological response rates underwent surgical resection. Results: Overall survival and progression-free survival were found to be statistically significantly higher in the surgical group (P = .03 and P = .01). Overall survival (P = .001) and progression-free survival (P = .001) were significantly higher in patients with pathological yp-Stage 0–1 compared to those with higher pathological stages. Conclusion: This study highlights the impact of pathological response rates following NACRT, with or without surgery, on treatment outcomes in esophageal cancer. Cite this article as: Çepni K, Uçgun TH, Şam Özdemir M, Aydın SN, Çepni B, Kızıltan HS. Impact of response rates on overall survival following chemoradiotherapy with or without surgery in esophageal cancer. Cerrahpaşa Med J 2026, 50, 0079, doi:10.5152/cjm.2026.25079.

Background/Objectives: D-dimer, a fibrin degradation product, is associated with tumor growth and metastasis. In breast cancer, high concentrations of D-dimer are linked to more advanced disease stages and metastatic spread. This research aimed to examine the relevance of D-dimer levels in estrogen and progesterone hormone receptor (HR)-positive breast cancer. Methods: This retrospective single-center cohort study included patients with HR-positive breast carcinoma who underwent adjuvant or palliative radiotherapy in Türkiye. Pre- and post-radiotherapy blood test results, including D-dimer levels, were required. D-dimer, lymphocyte percentage, and interleukin-6 levels were measured for evaluation. All statistical analyses were performed using R software (version 4.4.2) to evaluate associations between D-dimer levels and other laboratory parameters. Univariate and multivariate Cox proportional hazards regression were performed to identify prognostic factors for progression-free survival (PFS) and overall survival (OS). Statistical significance was defined as p < 0.05. Results: Elevated D-dimer levels were associated with worse Eastern Cooperative Oncology Group performance status, advanced disease stages, metastasis, elevated IL-6 and CRP levels, and lower lymphocyte counts. Pre-RT D-dimer was a strong prognostic factor. Patients with D-dimer ≤ 0.3 µg/mL showed significantly superior OS and PFS (>60 months; p < 0.001), with only one event, and this remained significant in multivariate analysis (OS: HR 4.55, 95% CI 1.89–11.3; p = 0.002; PFS: HR 3.43, 95% CI 1.54–7.8; p = 0.004). Similarly, D-dimer ≤ 0.5 µg/mL was associated with improved OS (4/72 vs. 19/40 events; p < 0.001) and longer PFS, confirmed in multivariate analysis (OS: HR 4.37, 95% CI 1.72–9.86; p = 0.002; PFS: HR 3.88, 95% CI 1.67–9.1; p = 0.003), whereas levels > 0.5 µg/mL predicted worse outcomes. Using a 0.65 µg/mL cutoff, patients with D-dimer > 0.65 µg/mL had significantly shorter OS (median 25.5 months; 95% CI, 18–NA) compared with those ≤0.65 µg/mL (median not reached; p < 0.001), and this remained independently significant (OS: HR 5.10, 95% CI 1.9–13.6; p < 0.001; PFS: HR 4.68, 95% CI 1.83–11.9; p = 0.002). Conclusions: D-dimer is an accessible, non-invasive biomarker with predictive and prognostic significance in HR-positive breast cancer. Elevated D-dimer levels are suggestive of a more aggressive disease and poorer survival outcomes. This has the potential to facilitate early assessment of treatment efficacy and disease progression. This study has several limitations. Its retrospective, single-center design may introduce selection bias and limit generalizability. Although the sample size was sufficient to detect significant associations, validation in larger, multi-center cohorts is warranted to confirm the prognostic value of D-dimer.

Background:The neutrophil-to-lymphocyte ratio (NLR) has emerged as a promising systemic inflammatory biomarker with potential prognostic value across various solid tumors. However, its prognostic significance in patients with esophageal cancer undergoing neoadjuvant chemoradiotherapy (nCRT) remains inconsistent. This study aimed to investigate the independent prognostic value of pretreatment NLR in patients with esophageal cancer treated with nCRT. Methods:This retrospective cohort study included 72 patients with stage II–IVA esophageal cancer who received nCRT between July 2020 and December 2023. Pretreatment NLR was calculated from complete blood count measurements obtained within one week before treatment initiation. The optimal NLR cutoff value was determined using maximally selected rank statistics. Overall survival (OS) and progression-free survival (PFS) were evaluated using the Kaplan–Meier method and Cox proportional hazards regression analyses. Results:The optimal pretreatment NLR cutoff was identified as 2.4 for both OS and PFS. Patients with an NLR >2.4 had significantly poorer PFS (p=0.013) and OS (p2.4 remained independently associated with worse PFS (HR=2.18, 95% CI: 1.09–4.37, p=0.028) and OS (HR=2.23, 95% CI: 1.11–4.49, p=0.024). In addition, poor response to nCRT was independently associated with inferior survival outcomes, whereas pretreatment NLR was not significantly associated with treatment response. Conclusions:Elevated pretreatment NLR was independently associated with poorer survival outcomes in patients with esophageal cancer treated with neoadjuvant chemoradiotherapy. Given the exploratory nature of the findings and the methodological limitations of the study, external validation using NLR as a continuous variable in adequately powered prospective cohorts is required before clinical implementation.